Provider Demographics
NPI:1164912374
Name:STOUT, JARON ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JARON
Middle Name:ANDREW
Last Name:STOUT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-0239
Mailing Address - Country:US
Mailing Address - Phone:888-221-0423
Mailing Address - Fax:888-271-9816
Practice Address - Street 1:1015 E 100 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4873
Practice Address - Country:US
Practice Address - Phone:888-853-8973
Practice Address - Fax:888-959-9385
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6947461-17011835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6947461-1701OtherSTATE OF UTAH PHARMACIST LICENSE